Type 2 diabetes mellitus

Type 2 diabetes is initially asymptomatic, meaning it does not show symptoms for a long time. Moreover, it progresses at a very slow pace, making it difficult for any key warning signs to appear early. This is why it is often said that the absence of symptoms is one of the most common signs of type 2 diabetes. However, there are some symptoms that may indicate type 2 diabetes, which include:

• Frequent urination
• Excessive thirst
• Increased hunger
• Unexplained weight loss
• Blurry eyesight
• Lack of energy/fatigue
• Delayed healing of cuts and other injuries
• Frequent yeast infections
• Numbness or tingling in the hands or feet
• Areas of darkened skin, usually affecting the armpits and neck
• Dry skin

Insulin is a hormone produced by the pancreas, which is located below and behind the stomach. Insulin helps to move blood sugar (glucose) into the cells, where it is stored and later used for energy.

In type 2 diabetes, the body does not respond correctly to insulin, a condition known as insulin resistance. As a result, blood glucose is unable to enter the cells for storage and energy use. This leads to a buildup of glucose in the blood, a condition referred to as hyperglycemia.

As blood glucose levels rise, the pancreas is stimulated to release more insulin. Over time, the pancreas may become unable to produce sufficient insulin to meet the body's needs, resulting in the symptoms associated with type 2 diabetes.

The factors that increase the risk of type 2 diabetes are as follows:

• Age: The risk of type 2 diabetes increases with age, especially after 45 years.
• Family history: The risk is higher if parents or siblings have the condition. Genetic predisposition to high cholesterol, high blood pressure, or cardiovascular disease can also increase the risk.
• Race and ethnicity: Certain races and ethnicities, such as African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander, are more likely to develop type 2 diabetes.
• Unhealthy eating habits: A calorie-dense diet with processed foods and beverages, along with a lack of whole, nutrient-rich foods, significantly increases the risk.
• Being overweight or obese: Fat stored in the abdominal region, with a waist circumference above 40 inches (101.6 centimeters) for men or above 35 inches (88.9 centimeters) for women, poses a higher risk.
• Sedentary lifestyle: Less physical activity can lead to weight gain and obesity, thereby increasing the risk of diabetes.
• Blood cholesterol levels: Low levels of high-density lipoprotein (HDL) cholesterol and high levels of triglycerides and low-density lipoprotein (LDL) can predispose individuals to type 2 diabetes.
• Prediabetes: In this condition, blood sugar levels are higher than normal but not high enough to be categorized as diabetes. If left untreated, prediabetes often leads to type 2 diabetes.
• Pregnancy-related issues: Gestational diabetes or giving birth to a child weighing more than 4 kilograms increases the risk of type 2 diabetes.
• Polycystic ovary syndrome (PCOS): PCOS, characterized by irregular menstrual cycles, excessive facial hair growth, and obesity, also increases the risk of diabetes.
• Smoking: Chemicals in cigarettes cause inflammation throughout the body and can lead to oxidative stress, both of which are related to an increased risk of diabetes.
• Sleep habits: Sleep disturbances can affect the body’s balance of insulin and blood sugar, increasing the demand on the pancreas and leading to diabetes.
• Stress: Stress can stimulate the release of various hormones, which may predispose individuals to high blood sugar levels.
• Anxiety and depression: Psychological issues such as depression are known to increase the risk of diabetes.

The common lab tests include blood tests and urine tests. In addition, your doctor might conduct a thorough physical examination to check for signs of any skin problems. Imaging tests may also be advised in some cases to assess the effects of diabetes on the nerves and other body organs. A psychiatric evaluation can be recommended for individuals during the initial stages, as many people experience a rejection phase before accepting their diabetes diagnosis.

The commonly recommended blood tests used to diagnose diabetes include:

• Random Blood Sugar Test: This test measures the levels of glucose circulating in the blood and can be performed at any time of the day without fasting. Diabetes is confirmed if blood glucose levels are greater than or equal to 200 mg/dl.
• Fasting Plasma Glucose Test (FPGT): This blood test measures glucose levels after fasting for 8-12 hours. Diabetes is confirmed if blood glucose levels are greater than or equal to 126 mg/dl.
• Postprandial Blood Glucose (PPBG) Test: Conducted 2 hours after the last meal, this test measures glucose levels to screen for prediabetes and monitor treatment efficacy. It is recommended when blood glucose levels fall between 140 and 200 mg/dl.
• Hemoglobin A1c (HbA1c) Test: This test measures a person’s average blood glucose level over the past 2 to 3 months. HbA1c levels of 5.7% to 6.4% indicate prediabetes, while levels higher than 6.5% indicate diabetes.
• Other Tests: If diagnosed with diabetes, you may need to undergo several health tests periodically to prevent complications and assess the effects of high glucose levels on other parts of the body. These include:
  • Blood pressure
  • Eye examination
  • Foot examination
  • Lipid profile
  • Kidney function test (KFT)
  • Liver function test (LFT)
  • Vitamin B12 test
  • Dental check-up

With simple lifestyle changes such as diet control, staying active, keeping a tab on your weight, and avoiding vices, you can lower your risk of type 2 diabetes. Here are a few tips to get started.

1. Make healthy food choices

Taking care of your diet is one of the most essential components to manage and prevent diabetes.

• Switch to oils with high volumes of monounsaturated fats and polyunsaturated fats like olive oil, canola oil, soybean oil, or rice bran oil. Limit intake to one tablespoon a day.
• Restrict intake of foods that have a high glycemic index like white breads, white rice, fatty foods, and soda.
• Consume foods with a low glycemic index like multigrain flour, whole grains, pulses, and non-starchy vegetables.
• Limit consumption of fast food.

2. Watch your weight

• Lose weight to attain a body mass index (BMI) between 18.5 and 24.9.
• Pay more attention to losing abdominal or belly fat, as it can increase the risk of type 2 diabetes more than fat on other parts of the body like thighs, hips, and buttocks.

3. Exercise regularly

• Regular exercise can lower blood glucose and possibly reduce the amount of medication you need to treat diabetes, or even eliminate the need for medication.
• Even if you do not lose any weight, exercise can help keep type 2 diabetes under control.
• Start slowly with low-impact exercises such as walking, swimming, or jogging.
• Exercise at least three times a week for about 30 to 45 minutes.
• Warm up for 5 minutes before starting to exercise and cool down for 5 minutes after exercising.
• Be more active throughout the day. Avoid sitting for more than 2 hours at a stretch.
• Parking your car far away, opting for stairs instead of the elevator, or walking instead of sitting while talking on the phone can increase physical activity.

4. Manage stress better

• Stress can make blood sugar levels harder to control.
• It is important to avoid unnecessary stress and engage in activities that help relieve stress such as reading, traveling, sports, and other hobbies.
• Mind-body practices such as tai chi and yoga can help manage stress and prevent diabetes.
• Consider joining a yoga club or dedicating 10-15 minutes every day for meditation.

5. Get a good quality sleep

• Make lifestyle changes to achieve sound sleep, such as going to bed and waking up at the same time every night and keeping electronics out of the bedroom.
• Sleep problems like sleep apnea can increase the risk of diabetes. If you have trouble sleeping, consult your doctor at the earliest.

6. Quit smoking

• Smoking has been found to directly increase the risk of several diabetes complications such as cardiovascular diseases, stroke, eye diseases, nerve damage, and kidney damage.
• It also reduces blood flow to the feet and other extremities, leading to problems in the feet and slowing down the healing of injuries.
• Quitting smoking is wise to lower your risk of diabetic complications. Talk to your doctor for measures that can help you quit.

7. Drink in moderation

• Excessive drinking can cause unexpected spikes in blood glucose, significantly affecting your overall health, especially if you have diabetes.
• Men should consume no more than 2 drinks per day, and women no more than 1 drink per day. If you are already diabetic, alcohol can worsen your condition.
• Do not drink on an empty stomach.

Diabetes can be treated with medications and injections along with a few lifestyle modifications. Based on your blood glucose level, your doctor might recommend medicines or injections to control diabetes. Some of the common types of medicines for diabetes include:

A. Oral Antidiabetics

1. Biguanides: This class of drug helps to improve glucose control by suppressing glucose production by the liver, decreasing the absorption of glucose by the intestine, and increasing insulin sensitivity. Metformin is the most commonly used biguanide to treat diabetes.
2. Sulphonylureas: These drugs increase the secretion of insulin by the pancreas to manage diabetes. Common examples include:
   • Glimepiride
   • Glipizide
3. Thiazolidinediones: This class of drugs helps control diabetes by increasing insulin sensitivity in the muscles and fat tissues. Examples include:
   • Pioglitazone
   • Rosiglitazone
4. Meglitinides: These drugs increase the secretion of insulin by the pancreas to treat diabetes. Examples include:
   • Repaglinide
   • Nateglinide
5. Alpha-glucosidase Inhibitors: This class of drugs inhibits the enzyme alpha-glucosidase, thereby decreasing the absorption of glucose by the intestine. Commonly available drugs include:
   • Acarbose
   • Miglitol
6. DPP-4 Inhibitors: These drugs improve the secretion of insulin by the pancreas, aiding in the treatment of diabetes. Examples include:
   • Sitagliptin
   • Vildagliptin
   • Saxagliptin
7. Incretin Mimetics: This class of oral antidiabetics increases the secretion of the hormone insulin and helps in controlling diabetes. Commonly known as glucagon-like peptide 1 (GLP-1) receptor agonists or GLP-1 analogues, this class includes drugs such as:
   • Exenatide
   • Liraglutide
   • Dulaglutide

B. Injectables

This includes insulin (mainly human insulin), which increases the uptake of glucose by the cells and helps to control diabetes. There are five different types of insulin currently available, recommended based on the severity of the condition. These include:

• Rapid-acting insulin (Examples: Lispro & Glulisine)
• Short-acting insulin (Examples: Insulin Regular & Semilente)
• Intermediate-acting insulin (Examples: Lente & Insulin Isophane)
• Long-acting insulin (Examples: Ultralente & Protamine Zinc)
• Ultra long-acting insulin (Examples: Glargine, Detemir & Degludec)

C. Latest Advancements

• Semaglutide: A GLP-1 receptor agonist used to manage type 2 diabetes by improving blood sugar control and supporting weight loss.
• Tirzepatide: A dual GIP/GLP-1 receptor agonist that enhances insulin release, reduces appetite, and promotes weight loss.

Note: Both are widely used for their effectiveness in controlling blood sugar, with Tirzepatide showing slightly better outcomes in weight loss and diabetes risk reduction.

A. Diet in diabetes

In the case of diabetes, it is essential to understand the concept of the glycemic index (GI). The glycemic index of a food refers to the effect the food has on the body's blood sugar levels. Foods are classified as low, medium, or high glycemic foods and ranked on a scale of 0–100. High GI is when the level is greater than 70, and low levels are less than 51. Diet in diabetes should include low GI foods whereas high GI foods should be avoided or limited. While choosing foods with a high GI, limit the portion size and pair them with sources of protein or healthy fat to reduce the impact on blood sugar.

Foods to prefer

• Vegetables: Vegetables contain a good quantity of vitamins, minerals and are a great source of fiber. Green, leafy vegetables are full of essential vitamins, minerals, and nutrients. They’re also very low in digestible carbohydrates, so they won’t significantly affect blood sugar levels. Examples include spinach, avocados, cabbage, beans, broccoli, and kale.
• Fruits: There is mixed perception about intake of fruits for diabetes. Some believe that diabetics should completely cut down fruits from their diet, while others think they can include as much fruit as they want without impacting blood glucose levels. However, it is best to include fruits as an integral part of your daily meal plan while monitoring the carbohydrate content.
• Protein-rich foods: Eating a protein-rich diet can be beneficial as proteins are broken down more slowly by the body than carbohydrates. They exert less effect on blood sugar levels and help to feel fuller for longer. Good sources of protein include fish, lean meats, and chicken.
• Whole grains: Whole grains contain higher levels of fiber and nutrients than refined white grains. A diet rich in fiber is important for people with diabetes as it slows digestion and helps keep blood sugar levels stable. Examples of whole grains include brown rice, quinoa, millet, and buckwheat.
• Seeds: Seeds like flax seeds and chia seeds are rich in fiber and low in digestible carbs. The fiber in seeds can lower blood sugar levels by slowing the rate at which food moves through the gut, aiding glycemic management in people with diabetes.
• Nuts: Nuts are a great source of fiber and vitamins and can help regulate cholesterol. Regular consumption of nuts may reduce blood sugar levels. Examples include walnuts, almonds, hazelnuts, and pistachios.

Foods to limit

• Carbohydrate-rich foods: Carbohydrates are an important part of all meals, but people with diabetes benefit from limiting their carbohydrate intake. Replacing carbs with alternative options or pairing them with a healthy protein source is advisable.
• Saturated and trans fats: Saturated and trans fats in fried and processed foods, including chips and baked goods, have been linked to higher spikes in blood glucose.
• Alcohol: People with diabetes are generally advised to limit alcohol intake to avoid sudden spikes in blood sugar levels.
• Sugar-sweetened beverages: Sugar-sweetened beverages like soda, energy drinks, and sweet tea lack important nutrients and contain a concentrated amount of sugar in each serving.
• Excessive salt: While salt is not directly linked to blood glucose levels, it is important to limit salt intake for diabetes management. High salt consumption can lead to high blood pressure, increasing the risk of heart disease, stroke, and kidney disease.

Dr. Beena Bansal (MBBS, MD, DM, Endocrinology) discusses simple ways to curb food cravings. Watch the video now!

B. Exercise in diabetes

Aerobic activity is an effective exercise option to control diabetes. When performed at moderate intensity, it raises your heart rate and induces sweating, helping maintain optimum blood glucose levels. Consider brisk walking, light jogging, swimming, or other aerobic exercises to maintain weight and manage diabetes.

C. Regular health check-ups in diabetes

Diabetes requires a lifelong commitment to a healthy lifestyle, timely medication, and regular checkups to detect any complications.

• Check your blood sugar levels at home at least once a week.
• Get your HbA1c levels checked at least twice a year.
• Ensure that your eyes, kidneys, heart, and skin are in optimal health.
• Visit an eye specialist once a year to detect any signs of eye damage (diabetic retinopathy).
• Get your kidney function tests done at least twice a year.
• Inspect your feet regularly for any signs of numbness, pain, or growth that may lead to ulceration and complications.

Insulin deficit, if left unchecked over the long term, can cause damage to many of the body’s organs, leading to disabling health complications such as:

• Diabetes retinopathy: High blood glucose levels increase the risk of eye problems such as blurred vision, cataract, and glaucoma.
• Diabetic nephropathy: Excess glucose can cause thickening of blood vessels in the kidneys, gradually impairing kidney function and increasing pressure on the kidneys, which can lead to chronic kidney failure.
• Diabetic neuropathy: High blood glucose levels can affect the nerves by impairing blood flow and damaging small blood vessels. This may result in tingling, numbness, pain, or eventual loss of feeling that typically begins at the tips of the toes or fingers and gradually spreads upward. Damage to the heart nerves can cause irregular heartbeat, while nerve damage in the digestive system can lead to nausea, vomiting, diarrhea, or constipation.
• Cardiovascular diseases: High blood glucose levels impair blood flow to the heart and increase the risk of atherosclerosis, leading to the narrowing of arterial walls throughout the body.
• Diabetic ulcers: People with diabetes have an increased risk of developing foot ulcers, which are often painless. Regular examination of the feet and legs is important to identify diabetic ulcers and seek prompt treatment if necessary.
• Recurrent infections: High blood sugar can weaken the immune system, making individuals more susceptible to bacterial and fungal infections.
• Delayed healing: Cuts and blisters can develop into serious infections due to poor healing. Type 2 diabetes also causes poor circulation to the feet, leading to delayed healing of any cut or infection, which can result in gangrene and loss of the foot or leg.
• Hearing impairment: Hearing problems are more common in people with type 2 diabetes.
• Sleep apnea: Obstructive sleep apnea is common in patients with type 2 diabetes.
• Dementia: Type 2 diabetes increases the risk of Alzheimer's disease and other conditions that cause dementia.
• Erectile dysfunction: Men with diabetes are at a higher risk of developing erectile dysfunction, often occurring 10-15 years earlier than in non-diabetics.

Ayurveda

The science of Ayurveda manages diabetes through a combination of activities that include exercise (vyayam), dietary regulation (pathya), panchakarma (bio-purification), and medicines. It is best to consult an Ayurveda consultant before taking any Ayurvedic medicine for diabetes. Some household herbs and spices that you can include in your diet are:

• Powdered jamun seeds can be taken with water or buttermilk (chaach).
• Methi (fenugreek) seeds are taken with water 15-20 minutes before each meal. Methi contains soluble fibers that slow down the digestion and absorption of glucose.
• Bael leaves are squeezed to prepare fresh juice that can be taken along with a pinch of black pepper.
• Dalchini (cinnamon) in powdered form can be taken with water as it helps improve sugar and cholesterol levels.
• Concentrated amla juice taken along with bitter gourd juice helps in releasing more insulin.
• Karela (bitter gourd) juice is recommended to be taken every morning.

Homeopathy

Defined as a complementary medicine, homeopathy primarily focuses on improving the functioning of the pancreas to produce insulin. Homeopathy experts rely on the patient’s history and temperament to devise constitutional medication. However, it is recommended to use homeopathic medicines only if prescribed by a homeopath and alongside the usual course of medications suggested.

Yoga

Yoga emphasizes mindful exercise where a person’s attention is directed towards the body or breathing, alleviating worrying or depressing thoughts from the mind. Restorative yoga involves yoga poses and healing through relaxation techniques with conscious breathing. Power yoga has also been found beneficial for weight loss, a risk factor for diabetics. It has been studied for controlling both the symptoms and complications associated with type 2 diabetes mellitus.

Acupuncture

This technique involves the insertion of very thin needles through the skin at strategic points of the body. Acupuncture may be effective in treating not only diabetes but also in preventing and managing complications of the disease.

Learn more about the condition by reading about its complications online. In case of any doubt, get your queries answered by your expert. This includes knowing when to check blood glucose levels, the lifestyle changes to follow, the type of glucometer to use, etc.

1. Know the highs and lows
Diabetes can put patients at risk of various health problems, including obesity, heart disease, and depression. Thus, it is essential to help patients control their blood glucose levels.

2. Go for appointments with the patient
Accompanying the patient can help you understand what extra precautions to take and what changes are necessary for proper diabetes management.

3. Follow the same diet pattern as the patient
This approach can make you more cautious about healthy eating. Sharing the same fitness plan can help reduce stress and promote health. Lifestyle changes become habits when practiced together. You can also receive diet-related advice through e-consultation.

4. Talk to other caregivers and let the patient connect with other diabetics
Sharing experiences can make it easier to manage diabetes and understand the condition better. Consider reaching out to diabetes communities or online support groups for assistance.